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Flashcards in Pathology: Uterus Deck (13)
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What is primary amenorrhea? Secondary amenorrhea? What are the potential causes?

- primary: absence of menses by age 16
- secondary: loss of menses for at least 6 months in a patient with otherwise normal menstrual history
- causes: pregnancy!, hypothalamic/pituitary disorder, ovarian disorder, anatomical defects


What is Asherman syndrome?

- Asherman syndrome is the acquired loss of the stratum basalis (the regenerative layer of the endometrium)
- it is usually due to overly aggressive dilatation and curettage
- this is a rare anatomical defect that can cause secondary amenorrhea (most anatomical defects are present at birth and therefore result in primary amenorrhea)


What usually causes endometritis? What finding characterizes chronic cases?

- endometritis is usually due to retained products of conception following delivery/miscarriage/abortion
- chronic cases are characterized by the presence of plasma cells (although chronic infections are related to lymphocytes, lymphocytes are normally already found in the uterus)


What are the main causes of abnormal uterine bleeding (AUB) in children? In early reproductive years (menarche to 20)? From 20 to 40? From 40 on?

- prepuberty: vulvovaginitis, embryonal rhabdomyosarcoma of vagina
- menarche to 20: anovulatory cycles due to excess unopposed estrogen, bleeding diathesis, pregnancy
- 20 to 40: pregnancy, PID, leiomyoma (fibroids), endometriosis, endometrial polyp, medication
- 40 on: perimenopause, endometrial hyperplasia and carcinoma


What are endometrial polyps? What are they a common cause of?

- these are benign collections of endometrial tissue
- they do NOT progress to carcinoma
- they are a common cause of AUB in females 20-40


What causes endometrial hyperplasia? What do we see on histology? How do patients classically present? What are the risk factors and complications?

- endometrial hyperplasia is due to unopposed estrogen, resulting in a constant proliferative phase of the menstrual cycle
- on histo we would see hyperplasia of the glands relative to the stroma
- patients present with AUB, classically with postmenopausal vaginal bleeding (the excessive proliferation results in sporadic cases of shedding)
- RFs: obesity, PCOS, anovulatory cycles, HRT, early menarche, late menopause, nulliparity
- complications: can develop into endometrial carcinoma, so *make sure to take a biopsy to check for the architectural growth (simple or complex) and presence of atypia (typical or atypical)*


What is the most common gynecological malignancy? How does it present? What are the two pathways of development? What are the major risk factors?

- endometrial carcinoma is the most common gynecological malignancy (followed by ovarian and then by cervical)
- classically presents in a 55-65 year old female with postmenopausal bleeding
- two distinct pathways: hyperplastic (following endometrial hyperplasia; usually seen in 50s) and sporadic (occurs in an atrophic endometrium with no precursor lesions; usually seen in 70s)
- RFs: (same as endometrial hyperplasia) obesity, PCOS, anovulatory cycles, HRT, early menarche, late menopause, nulliparity


Which type of endometrial carcinoma contains psammoma bodies? Which other carcinomas contain psammoma bodies?

- the sporadic form of endometrial carcinoma that develops in an atrophic (postmenopausal) uterus without a precursor lesion (AKA without endometrial hyperplasia)
- contains serous (AKA papillary-serous) histology that can calcify and form psammoma bodies
- PSaMMoma bodies: Papillary thyroid carcinoma, Serous endometrial and Serous ovarian carcinoma, Mesothelioma, Meningioma


What is endometriosis? Where does it most commonly occur? What is it the most common cause of? What are some complications?

- endometriosis is the presence of functional endometrial tissue outside the uterus (most common site is the ovary, also the pelvis and peritoneum)
- it is the most common cause of secondary dysmenorrhea (pain on period); it is also the most common gynecological disorder in the reproductive age group
- patients can also present with dyschezia (suggests involvement of the pouch of Douglas), and dyspareunia
- complications: infertility, ectopic pregnancy, carcinoma at the site of involvement (especially with the ovaries)
- (involvement of the ovaries leads to formation of chocolate ovarian cysts)


What is adenomyosis? What causes it?

- adenomyosis is essentially endometriosis within the myometrium
- this is caused by hyperplasia of the stratum basalis layer of the endometrium into the myometrium
- in adenomyomis, the uterus is uniformly enlarged (in endometriosis, the uterus is normal)


What is a fibroid? Which age does it most commonly affect?

- a fibroid is a leiomyoma (a benign growth of the smooth muscle of the myometrium)
- they are the most common tumor in females!
- peak occurrence at 20-40 (a common cause of AUB in this age group, but are usually asymptomatic)
- *leiomyomas do NOT progress to leiomyosarcomas*


What are the major differences between a leiomyoma and a leiomyosarcoma?

- leiomyoma: usually multiple masses, well-defined, white-whorled pattern of smooth muscle bundles, more common in reproductive age group
- leiomyosarcoma: usually a single mass, necrotic and hemorrhaging, more common in postmenopausal age group (leiomyosarcomas arise de novo)


What is the pathophysiology behind dysmenorrhea? How do treat it?

- dysmenorrhea is largely a result of excessive eicosanoids (prostaglandins and related compounds), which occurs as a result of an excessive inflammatory response that occurs after ovulation in the endometrium; this leads to irregularly strong and painful contractions
- the main culprit is PGF2alpha (plays a major role in contracting uterine vessels, contracting uterine smooth muscle, and sensitizing endometrial nociceptors)
- (note that the anti-contracting prostacyclin is actually decreased in these patients!)
- treat with NSAIDs; OCPs also help by preventing ovulation and keeping the endometrial lining thin (lessens the inflammatory response)